Ureterohydronephrosis, Kidney, Ureter, Bilateral lesion, Symptoms, Causes of disease

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American Journal of Medicine and Medical Sciences 2022, 12(2): 126-128 
DOI: 10.5923/j.ajmms.20221202.12 
Ways to Improve the Surgical Treatment of Obstructive 
Ureterohydronephrosis in Children 
Atakulov Zhamshed Ostonokulovich
1
, Yusupov Shukhrat Abdurasulovich
2
,
Rakhmatov Bekzod Nasretdinovich
3
, Rakhimov Fakhridin Eshmamatovich
4
,
Abbosov Hozhimuhammad Khabibullaevich
5
 
1
Doctor of Medical Sciences, Professor of the Department of Pediatric Surgery, Samarkand State Medical Institute 
2
Doctor of Medical Sciences, Professor, Head of the Department of Pediatric Surgery No. 1 of the Samarkand State Medical Institute
 
3
Assistant of the Department of Pediatric Surgery No. 1, Samarkand State Medical Institute 
4
Senior Lecturer of the Department of Pediatric Surgery No. 1 of the Samarkand State Medical Institute
 
5
Resident of the Magistracy of the Department of Pediatric Surgery No. 1, Samarkand State Medical Institute 
Abstract
Hydronephrosis and ureterohydronephrosis. A pathological condition associated with the transformation of the 
kidney, the expansion of the ureter and the development of malnutrition or atrophy of the parenchyma of the kidney against 
the background of a violation of the outflow of urine and its blood supply. According to statistics, ureterohydronephrosis is 
quite common. In childhood, it is recorded mainly in boys, more often on the left - a bilateral lesion is diagnosed in 15% of 
cases. 
Keywords
Ureterohydronephrosis, Kidney, Ureter, Bilateral lesion, Symptoms, Causes of disease 
1. Introduction 
First of all, let's pay attention to the spelling of the 
diagnosis: Internet sources often confuse (or even use as 
synonyms) the concepts of "urethra" and "ureter". Leaving 
this on the conscience of the authors, nevertheless, we will 
clarify: the urethra is the final (distal, remote) section of the 
urinary tract, the urethra itself. The ureter is the ureter, a thin 
"hose" of connective tissue through which the fluid (urine) 
used after filtering the blood flows from the kidney to the 
bladder. Since the right kidney is located slightly lower than 
the left, the right ureter is also normally a few centimeters 
shorter; in addition, due to anatomical differences, the 
ureters are shorter in women. In general, their length in 
adults varies between 22-30 cm, while the thickness in 
different areas is different and amounts to 3-10 mm. 
And between the ages of 20 and 40, the disease occurs in
1% of people. Women suffer twice as often as men, which
is associated with pregnancy and the prevalence of tumor 
gynecological pathology. 
Further, 
hydronephrosis, 
or 
hydronephrotic 
transformation, is a pathological condition of the kidney, in 
which its cavities are mechanically expanded from the inside 
by excess fluid pressure on the walls. This pathology is 
considered to be quite common, although there are 
apparently no exact statistical data in terms of the proportion 
Received: Jan. 25, 2022; Accepted: Feb. 11, 2022; Published: Feb. 15, 2022 
Published online at http://journal.sapub.org/ajmms 
of the healthy population: the spread of published estimates 
is too large. It is known, however, that in the volume of all 
officially diagnosed nephropathologist, the proportion of 
hydronephrosis is approximately 5%, and among the causes 
of hospitalization in nephrological and urological hospitals - 
about 2%.
It is important to note that hydronephrosis is not a 
harmless anatomical anomaly: chronically elevated pressure 
of excess fluid not only stretches the pelvicalyceal system of 
the kidney, but also inevitably disrupts its performance. 
Under such conditions, nephrons (single cells of the renal 
parenchyma - functional, filtering tissue) receive insufficient 
nutrition, their dystrophy begins and progresses, and then 
atrophy - complete functional failure of specialized cells, 
massive "failure" and death, reduction of parenchymal
tissue in volume. The quantitative proportion between 
functioning and atrophied nephrons largely determines the 
clinical picture, prognosis, and therapeutic strategy for 
hydronephrosis. The cause of ureterohydronephrosis is a 
violation of the laying in the embryonic period of the organs 
of the urinary system at the level of the ureter-bladder. 
A 
sharp 
violation 
of 
urodynamics 
in 
ureterohydronephrosis that occurs in the prenatal period 
rapidly leads to impaired kidney function, and in a bilateral 
process, in the absence of a timely and high-quality operation, 
leads to renal failure. Early diagnosis and treatment 
according to indications is the key to success in this type of 
pathology. 

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American Journal of Medicine and Medical Sciences 2022, 12(2): 126-128 
127 
Finally, the prefix "uretero-" to this diagnosis means that 
under the influence of the pathological distribution of 
pressures, not only the renal structures proper, but also the 
corresponding ureter expand. It is easy to see that this 
situation is more complex and severe compared to "simple" 
hydronephrosis, often requiring more radical intervention. 
Ureterohydronephrosis is a pathological expansion of the 
pelvis and calyces of the kidneys, as well as the ureter. It 
develops in violation of the natural outflow of urine. 
Pathology is dangerous because it leads to the death of 
kidney cells and causes acute renal failure. Therefore, it is 
very important to consult a doctor in a timely manner for the 
diagnosis and treatment of ureterohydronephrosis. 
In pediatric practice, megaureter is one of the diseases that 
lead to impaired renal function, moreover, in a bilateral 
process, up to renal failure. With the expansion of the ureter, 
its transport function suffers and it becomes impossible to 
quickly move urine into the bladder and remove the 
microbial flora penetrating the urinary tract, causing chronic 
inflammation of the kidneys (pyelonephritis). Another 
dangerous consequence of the stagnation of urine in the 
ureter is an increase in pressure in the renal pelvis and 
calyces, which causes impaired renal circulation. The 
outcome of chronic inflammation and impaired renal 
circulation is scarring of the renal tissue (parenchyma) with 
loss of function (secondary wrinkling of the kidney, 
nephrosclerosis). 
What are the causes of megaureter? There are several 
reasons for the formation of a megaureter. The main reason 
is increased pressure inside the ureter with difficulty in the 
outflow of urine. And sometimes the pressure is normalized, 
and the expansion of the ureter remains. There is also 
congenital insufficiency of the muscular membrane of the 
ureter. In this case, the normal muscle layer of the ureter is 
replaced by scar inelastic tissue. The ureter is so weak that it 
is unable to effectively push urine into the bladder. Another 
cause of a megaureter is a narrowing of the ureter at its 
junction with the bladder. High-grade vesicoureteral reflux 
(VUR - reflux of urine from the bladder into the ureter and 
kidney) can also be the cause of the development of a 
megaureter. Bilateral megaureter is more often the result of a 
violation of the outflow of urine through the urethra, due to 
the presence of a congenital valve in the urethra or persistent 
spasm of the urethral sphincter, which occurs in neurological 
disorders. Such a megaureter is called secondary. 
How is megaureter manifested? Megaureter is usually 
diagnosed by fetal ultrasound. After birth, in the absence of 
pathology of the bladder and urethra, the megaureter usually 
does not manifest itself clinically. In the future, if the 
diagnosis was not made in utero, the disease may manifest 
itself as an unexpected attack of pyelonephritis. Older 
children sometimes complain of pain in the abdomen or in 
the lumbar region, an admixture of blood in the urine, There 
are 2 main forms of the disease - acute and chronic. 
Acute symptoms are: 

pain in the lower abdomen; 

frequent urge to urinate (mainly at night); 

high blood pressure; 

renal colic. 
The patient may notice reddening of the urine due to the 
appearance of blood impurities in it. Also, patients complain 
of weakness and general malaise, as well as lack of appetite. 
In the chronic form, it may be asymptomatic for several 
years. 
Diagnosing ureterohydronephrosis is quite difficult 
because of the pronounced symptoms that are characteristic 
of this particular disease. 
The first time the presence of a megaureter is usually 
reported by a specialist in ultrasound diagnostics. If a 
megaureter is found in a child with ultrasound, it is necessary 
to prepare for a complete urological examination to 
determine the cause, prognosis and treatment tactics. 
Intravenous (excretory) urography allows you to see the 
anatomical structure of the ureters, to determine how well the 
kidneys produce urine and are released from it. On urograms, 
the diameter of the ureters can be seen, which, with a 
megaureter, is more than 7-10 mm. 
Voiding cystourethrography (VCUG) is performed if 
vesicoureteral reflux is suspected (reflux of urine from the 
bladder into the ureter), to determine the patency of the 
urethra, exclude vesicoureteral reflux, and indirectly assess 
bladder function. 
Radioisotope examination of the kidneys (static or 
dynamic nephroscintigraphy) - is performed to assess the 
function of the kidneys and the degree of violation of the 
outflow of urine through the affected ureter. 
Ureterohydronephrosis is a pathological expansion of the 
pelvis and calyces of the kidneys, as well as the ureter.
It develops in violation of the natural outflow of urine. 
Pathology is dangerous because it leads to the death of 
kidney cells and causes acute renal failure. 
Children operated on by the method of urethrocystone 
anastomosis, in the immediate postoperative period, 
complained of an intermittent stream of urine, discomfort at 
the end of urination, pain at the end of urination, a feeling of 
urge to urinate after the act of micturition, as well as pain 
during urination. These clinic was associated with the 
condition after the operation of ureterocystone anastomosis 
(bladder injury, urethral catheterization, urinary infection 
and exacerbation of chronic cystitis); after appropriate 
treatment, the above symptoms ceased.